This Week in Cardiology

Dual antiplatelet therapy after PCI, statin side effects, nightshift work and AF, and a cautionary note regarding therapeutic enthusiasm in HF care are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - COVID

- Alaska Sets Record for Daily COVID Cases https://www.medscape.com/viewarticle/958999

II - MASTER DAPT

- MASTER DAPT: 1 Month DAPT Enough After High-Bleeding-Risk PCI https://www.medscape.com/viewarticle/957463

- Antiplatelets and Anticoagulation Post-PCI: More on MASTER DAPT https://www.medscape.com/viewarticle/958002

- Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk https://www.nejm.org/doi/full/10.1056/NEJMoa2108749

- Abbreviated Antiplatelet Therapy in Patients at High Bleeding Risk With or Without Oral Anticoagulant Therapy After Coronary Stenting: An Open-Label, Randomized, Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056680

III - Statins and Side Effects

- Most Muscle Pain on Statins Not a Drug Effect: SAMSON in Print https://www.medscape.com/viewarticle/958877

- Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment https://doi.org/10.1016/j.jacc.2021.07.022

IV - Nightshift Work and AF

- Regular Nightshift Work Linked to Atrial Fibrillation, CHD https://www.medscape.com/viewarticle/959346?src=

- Long-term night shift work is associated with the risk of atrial fibrillation and coronary heart disease https://doi.org/10.1093/eurheartj/ehab505

V - Enthusiasm for HF Therapy

- Empagliflozin's HFpEF Efficacy Catalyzes Redefinition of HF https://www.medscape.com/viewarticle/959249

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Cardiac arrest care, finerenone, carotids, meds post TAVI: less is more and the new may not be as grand as the tried and true. John Mandrola, MD, provides a third ESC review. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - Cardiac Arrest Care

- Angiography Can Wait for Cardiac Arrest Without ST-Elevation https://www.medscape.com/viewarticle/957471

- Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa2101909

- Coronary Angiography after Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa1816897

II - Finerenone

- FIDELITY: Finerenone Cuts CV Risk in T2D Across CKD Spectrum https://www.medscape.com/viewarticle/957470

- Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2110956

- Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2025845

III - Carotid Intervention

- ACST-2: Carotid Stenting, Surgery on Par in Asymptomatic Patients https://www.medscape.com/viewarticle/957474

- Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy https://doi.org/10.1016/S0140-6736(21)01910-3

IV - Post TAVI DOAC

- 'Less Is More' for Edoxaban in Post-TAVI Anticoagulation: ENVISAGE-TAVI AF https://www.medscape.com/viewarticle/957466

- Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR https://www.nejm.org/doi/full/10.1056/NEJMoa2111016

- ATLANTIS Hints at How to Choose Post-TAVR Antithrombotics https://www.medscape.com/viewarticle/951234

- A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement https://www.nejm.org/doi/full/10.1056/NEJMoa1911425

Features:

- What Are the Implications of ACST-2 for Patients With Asymptomatic Carotid Stenosis? https://www.medscape.com/viewarticle/957502

- Top 5 Studies From ESC 2021 https://www.medscape.com/viewarticle/958598

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ESC Wrap-up Part II: EMPEROR-Preserved, and the STEP, Guide-HF, and IAMI trials, are discussed by John Mandrola, MD, in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

I - HFpEF

- EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405

- Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

II - BP Targets

- STEP: Lowering Blood Pressure Below 130 mm Hg Shows CV Benefit https://www.medscape.com/viewarticle/957566

- Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2111437

III- PA Catheter Monitoring

- GUIDE-HF: CardioMEMS-Guided Meds Fall Short in Mild to Moderate Heart Failure https://www.medscape.com/viewarticle/957390

- Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2

- Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial https://doi.org/10.1016/S0140-6736(11)60101-3

IV - Influenza Vaccine

- Seasonal Flu Vax Cuts Post-MI Mortality in IAMI Trial https://www.medscape.com/viewarticle/957575

- Influenza Vaccination after Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial https://doi.org/10.1161/CIRCULATIONAHA.121.057042

- Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis https://pubmed.ncbi.nlm.nih.gov/20332404/

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EMPEROR-Preserved, the LOOP study, ablate-and-pace for AF, and salt substitute and stroke: John Mandrola, MD provides a first of two ESC reviews. To read a partial transcript or to comment, visit: https://www.medscape.com/twic

1 - HFpEF

- EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405

- Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

- Empagliflozin and Major Renal Outcomes in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMc2112411

- Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2022190

2 - AF Screening

- LOOP Trial Undercuts Value of Long-term Continuous ECG Screening for Atrial Fibrillation https://www.medscape.com/viewarticle/957473

- Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01698-6/fulltext

- Subclinical Atrial Fibrillation and the Risk of Stroke https://www.nejm.org/doi/full/10.1056/nejmoa1105575

3 - Ablate and Pace for AF and HF

- APAF-CRT: 'Ablate and Pace' Cuts Mortality in Narrow-QRS HF, Permanent AF https://www.medscape.com/viewarticle/957467

- A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS https://academic.oup.com/eurheartj/article/39/45/3999/5078460

- AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial https://doi.org/10.1093/eurheartj/ehab569

4 - Salt Substitute and Stroke

- Salt Substitute Shows Clear Reduction in Stroke, CV Events, and Death https://www.medscape.com/viewarticle/957472

- Effect of Salt Substitution on Cardiovascular Events and Death https://www.nejm.org/doi/full/10.1056/NEJMoa2105675

Features:

- Incremental, Not Monumental, Win for Empagliflozin in Heart Failure With Preserved Ejection Fraction https://www.medscape.com/viewarticle/957465

- Empagliflozin in HFpEF: Putting EMPEROR-Preserved in Context https://www.medscape.com/viewarticle/957388

- Lessons on AF Screening From the LOOP Study https://www.medscape.com/viewarticle/957512

- Ablate-and-Pace Delivers a Huge Win for Those Sick With AF https://www.medscape.com/viewarticle/958033

- Will the Positive Findings From the SSaSS Trial on Salt Substitution Silence the Salt Skeptics? https://www.medscape.com/viewarticle/957510

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Questions or feedback, please contact [email protected]

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COVID-19, NEJM vaccine safety paper, full-dose anticoagulation in COVID-19, AF and Exercise, and early results on EMPEROR-Preserved are the studies John Mandrola, MD, discusses in this week's podcast. https://www.medscape.com/twic

1 - COVID-19

- Heart Inflammation More Common After COVID Than After Vaccination https://www.medscape.com/viewarticle/957343

- Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting https://www.nejm.org/doi/full/10.1056/NEJMoa2110475

2 - Full dose AC in COVID-19

- Heparin's COVID-19 Benefit Greatest in Moderately Ill Patients https://www.medscape.com/viewarticle/956630

- Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2105911

- Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMoa2103417

3 - AF and Exercise

- Aerobic Exercise Can Reduce AF Frequency, Severity: ACTIVE-AF https://www.medscape.com/viewarticle/957322

4 - EMPEROR AF

- EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405

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Questions or feedback, please contact [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

COVID-19, Simpson's Paradox, LAA appendage closure, multimorbidity, and an ESC preview are the topics John Mandrola, MD discusses in today's podcast. https://www.medscape.com/twic

1 - COVID-19

- Lacking Beds, Hospitals Ship COVID-19 Patients to Other States https://www.medscape.com/viewarticle/956917

- Efficacy and Safety of Same-Day Discharge for Atrial Fibrillation Ablation https://pubmed.ncbi.nlm.nih.gov/32553209/

2 - Simpson's Paradox

- Israeli data: How can efficacy vs. severe disease be strong when 60% of hospitalized are vaccinated? https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated

- Simpson's Paradox and Interpreting Data https://towardsdatascience.com/simpsons-paradox-and-interpreting-data-6a0443516765

- How SIMPSON'S PARADOX explains weird COVID19 statistics https://www.youtube.com/watch?v=t-Ci3FosqZs

3 - Left Atrial Appendage Closure

- FDA Approves Abbott's Amplatzer Amulet for Atrial Fibrillation https://www.medscape.com/viewarticle/956726

- Chronic Kidney Disease Tied to Worse LAAO Outcomes https://www.medscape.com/viewarticle/956778

- The Association of Chronic Kidney Disease With Outcomes Following Percutaneous Left Atrial Appendage Closure https://www.jacc.org/doi/full/10.1016/j.jcin.2021.06.008

- Prophylactic Use of Implantable Cardioverter-Defibrillators in the Prevention of Sudden Cardiac Death in Dialysis https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.039818

4 - ESC Preview

- SGLT2 inhibitors in HFpEF

- EMPEROR-Preserved: Positive Top-Line Results for Empagliflozin in HFpEF https://www.medscape.com/viewarticle/954284

- AF Screening

- Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in individuals at risk (the LOOP study): Rationale and design of a large randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/28454796/

5 - Coming soon

The anticoagulation in COVID-19 trial is one of the hardest I have seen in years. Stay tuned.

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Questions or feedback, please contact [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

COVID-19, vaccine-induced myocarditis, Watchman complications, SGLT2 inhibitors, and cardiogenic shock are the topics John Mandrola, MD, discusses in this week's podcast. https://www.medscape.com/twic

1 - COVID-19

- 18 Months Later, the COVID-19 Memories Won't Go Away https://www.medscape.com/viewarticle/956335

2 - Vaccine-Myocarditis

- Myocarditis in Adolescents After COVID-19 Vaccine Typically Mild https://www.medscape.com/viewarticle/956359

- Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052

3 - Watchman

- 'Striking' Difference in Adverse Events in Women With Watchman LAAO https://www.medscape.com/viewarticle/956593

- Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion https://jamanetwork.com/journals/jamacardiology/fullarticle/2782726

4 - SGLT2 Inhibitors

- EU Approves Dapagliflozin for Kidney Disease, Regardless of Diabetes https://www.medscape.com/viewarticle/956345

- Dapagliflozin in Patients with Chronic Kidney Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2024816

5 - Cardiogenic Shock

- No Win for Milrinone Over Dobutamine in Cardiogenic Shock https://www.medscape.com/viewarticle/956222

- Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock https://www.nejm.org/doi/full/10.1056/NEJMoa2026845

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Questions or feedback, please contact [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The COVID-19 surge, vaccine-induced myocarditis, Heart Rhythm news, the state of medical evidence, and doctors in unions are discussed by John Mandrola, MD, in this week's podcast.

https://www.medscape.com/twic

1- COVID-19

Texas COVID-19 Wave Is Climbing More Steeply Than Past Waves https://www.medscape.com/viewarticle/956104

White House Says US Can Provide COVID-19 Boosters if Needed https://www.medscape.com/viewarticle/956016

2- Vaccine-Myocarditis

Myocarditis Tied to COVID-19 Shots More Common Than Reported? https://www.medscape.com/viewarticle/956089

3- Heart Rhythm News

The Three Big Stories from the Heart Rhythm Society's 2021 Meeting https://www.medscape.com/viewarticle/955989

4- Medical Evidence

Despite Retraction, Study Using Fraudulent Surgisphere Data Still Cited https://www.medscape.com/viewarticle/956090

Ongoing Citations of a Retracted Study Involving Cardiovascular Disease, Drug Therapy, and Mortality in COVID-19 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2782460

5- Doctors in Unions?

Physicians Need to Unionize Now https://www.medscape.com/viewarticle/955888

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Questions or feedback, please contact [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Two studies on alcohol and AF incidence and an important paper on stable CAD are the topics John Mandrola discusses in this week's podcast. https://www.medscape.com/twic

1 - COVID-19

New Vaccinations Increasing in COVID Hot Spots https://www.medscape.com/viewarticle/955680

2 - Alcohol

- Moderate Drinking Protective After MI, Stroke in 'Flawed' Study https://www.medscape.com/viewarticle/955474

- Risk Thresholds for Total and Beverage-Specific Alcohol Consumption and Incident Atrial Fibrillation https://doi.org/10.1016/j.jacep.2021.05.013

- Can a Drink a Day Keep the Electrophysiologist Away? https://doi.org/10.1016/j.jacep.2021.06.010

- Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02040-2

3 - Coronary Artery Disease

- CLARIFY Confirms Meds, Watchful Waiting in Angina, Stable CAD https://www.medscape.com/viewarticle/955313

- International Observational Analysis of Evolution and Outcomes of Chronic Stable Angina: The Multinational Observational CLARIFY Study https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.121.054567

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Questions or feedback, please contact [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

COVID-19 messaging, coffee, CTA and statins, and Watchman problems are the topics discussed by John Mandrola, MD, in this week's podcast. https://www.medscape.com/twic

1- COVID-19:

- COVID-19 Cases in US Triple Over 2 Weeks Amid Misinformation https://www.medscape.com/viewarticle/955269

- Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant https://www.nejm.org/doi/full/10.1056/NEJMoa2108891

- What Really Happened With that Weird Yankees COVID Outbreak https://nymag.com/intelligencer/2021/05/what-really-happened-with-that-weird-yankees-covid-outbreak.html

2- Coffee:

- Coffee Not Linked to Increased Arrhythmia Risk in New Study https://www.medscape.com/viewarticle/954992

- Coffee Consumption and Incident Tachyarrhythmias https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782015

- Another Cup of Coffee Without an Arrhythmia, Please https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2782021

3- CTA and Statins:

- CTA May Guide Primary Prevention Statins in Nonobstructive CAD https://www.medscape.com/viewarticle/955030

- Reduction of Myocardial Infarction and All-Cause Mortality Associated to Statins in Patients Without Obstructive CAD https://www.jacc.org/doi/full/10.1016/j.jcmg.2021.05.022

4- Left Atrial Appendage Closure:

- Five Risk Factors May Predict Thrombus on LAA Occlusion Implants https://www.medscape.com/viewarticle/955131

- Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion https://www.jacc.org/doi/full/10.1016/j.jacc.2021.04.098

- Device-Related Thrombus After Left Atrial Appendage Occlusion https://www.jacc.org/doi/10.1016/j.jacc.2021.05.028

Features:

- Does Coffee Make Your Heart Flutter? https://www.medscape.com/viewarticle/954996

- Enough With the Coffee Research and Other Distractions https://www.medscape.com/viewarticle/883709

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Questions or feedback, please contact [email protected]

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.